Wisconsin
Provider Communications

Articles Category: State & Federal

Title Publication Category Date

HEDIS 2021 Federal Employee Program® medical record request requirements

April 2021 Anthem Provider News - Wisconsin Federal Employee Plan (FEP) Apr 1, 2021

Medicaid News - April 2021

View these Medicaid articles:
- There is something new happening at Anthem Blue Cross and Blue Shield
- Iron infusion medical step therapy notice
- November 2020 medical policies and utilization management guidelines update
- Prior authorization updates for specialty pharmacy drugs effective April 2021
- Prior authorization required for specialty pharmacy drugs effective May 2021
- Clinical criteria updates notification - November 2020
- Clinical criteria updates notification - December 2020
April 2021 Anthem Provider News - Wisconsin Medicaid Apr 1, 2021

Does your practice offer telehealth services? Let us know!

April 2021 Anthem Provider News - Wisconsin Medicare Apr 1, 2021

In-Office Assessment program

April 2021 Anthem Provider News - Wisconsin Medicare Apr 1, 2021

Oncology dose reduction program beginning July 1, 2021

April 2021 Anthem Provider News - Wisconsin Medicare Apr 1, 2021

Clinical criteria updates notification - November 2020

April 2021 Anthem Provider News - Wisconsin Medicare Apr 1, 2021

Clinical criteria updates notification - December 2020

April 2021 Anthem Provider News - Wisconsin Medicare Apr 1, 2021

Access to more claim denial information is now self-service

March 2021 Anthem Provider News - Wisconsin Medicaid Mar 1, 2021

MCG Care Guidelines 24th edition customization

March 2021 Anthem Provider News - Wisconsin Medicaid Mar 1, 2021

Updated AIM Rehabilitative program effective August 1, 2021 - Site of Care reviews

March 2021 Anthem Provider News - Wisconsin Medicaid Mar 1, 2021

Coding spotlight: Overview of the 2021 evaluation and management changes

March 2021 Anthem Provider News - Wisconsin Medicaid Mar 1, 2021

Medicare News - March 2021

View these Medicare articles:
- MCG Care Guidelines 24th edition customization
- DME checklist of information needed from providers
March 2021 Anthem Provider News - Wisconsin Medicare Mar 1, 2021

New provider directory indicator for telehealth services

March 2021 Anthem Provider News - Wisconsin Medicare Mar 1, 2021

Medical policies and clinical utilization management guidelines update

March 2021 Anthem Provider News - Wisconsin Medicare Mar 1, 2021

Access to more claim denial information is now self-service

March 2021 Anthem Provider News - Wisconsin Medicare Mar 1, 2021

Medicaid News - February 2021

View these Medicaid articles:
- Delay of AIM Musculoskeletal Program guideline updates for Medicaid
- New specialty pharmacy medical step therapy requirements
- Provider notification for Utilization Management Authorization Rule Operations Workgroup Item 1326
February 2021 Anthem Provider News - Wisconsin Medicaid Feb 1, 2021

Availity Portal eligibility and benefits provides both additional benefit notes and digital member ID Cards

February 2021 Anthem Provider News - Wisconsin Medicaid Feb 1, 2021

Medical drug benefit clinical criteria updates - February 2021

February 2021 Anthem Provider News - Wisconsin Medicaid Feb 1, 2021

CAHPS® survey

February 2021 Anthem Provider News - Wisconsin Medicaid Feb 1, 2021

HEDIS Measurement Year 2020: Medicaid summary of changes from NCQA

February 2021 Anthem Provider News - Wisconsin Medicaid Feb 1, 2021

PN for UM AROW Item 1330

February 2021 Anthem Provider News - Wisconsin Medicare Feb 1, 2021

Medical drug benefit clinical criteria updates - February 2021

February 2021 Anthem Provider News - Wisconsin Medicare Feb 1, 2021

2021 FEP® benefit information available online

January 2021 Anthem Provider News - Wisconsin Federal Employee Plan (FEP) Jan 1, 2021

Medicaid News - January 2021

View these Medicaid articles:
- August 2020 Medical Policies and Utilization Management Guidelines update
- Independent laboratory provider – Place of service 81
- New specialty pharmacy medical step therapy requirements
- Prior authorization requirements for Moderate to Deep Anesthesia for Dental Surgery in the Facility Setting
- Policy Update: Nurse Practitioner and Physician Assistant Services
- Updates to AIM Clinical Appropriateness Guidelines for Radiation Oncology
- Updates to AIM Specialty Health Cardiac Clinical Appropriateness Guidelines
January 2021 Anthem Provider News - Wisconsin Medicaid Jan 1, 2021

Updates to AIM clinical appropriateness guidelines for Advanced Imaging

January 2021 Anthem Provider News - Wisconsin Medicaid Jan 1, 2021

FDA approvals and expedited pathways used - new molecular entities (NMEs)

January 2021 Anthem Provider News - Wisconsin Medicaid Jan 1, 2021

Medical drug benefit clinical criteria updates

January 2021 Anthem Provider News - Wisconsin Medicaid Jan 1, 2021

Disease Management/Population Health program

January 2021 Anthem Provider News - Wisconsin Medicaid Jan 1, 2021

Coding spotlight: HEDIS MY 2021

January 2021 Anthem Provider News - Wisconsin Medicaid Jan 1, 2021

Keep up with Medicare news - January 2021

View these Medicare articles:
- Medicare Advantage Group Retiree Quick Reference Guide and FAQ
- Medicare Advantage Group Retiree Member Eligibility, Alpha Prefix FAQ
- SNF admission reporting requirements for D-SNP plans
- Policy Update: Nurse Practitioner and Physician Assistant Services – Professional
- Updates to AIM Clinical Appropriateness Guidelines for Radiation Oncology
- Updates to AIM Specialty Health Cardiac Clinical Appropriateness Guidelines
January 2021 Anthem Provider News - Wisconsin Medicare Jan 1, 2021

2020 Medicare risk adjustment provider trainings

January 2021 Anthem Provider News - Wisconsin Medicare Jan 1, 2021

Updates to AIM clinical appropriateness guidelines for Advanced Imaging

January 2021 Anthem Provider News - Wisconsin Medicare Jan 1, 2021

Updates to AIM Specialty Health Cardiac clinical appropriateness guidelines

January 2021 Anthem Provider News - Wisconsin Medicare Jan 1, 2021

Medical drug benefit clinical criteria updates

January 2021 Anthem Provider News - Wisconsin Medicare Jan 1, 2021

Medicaid News - December 2020

View these Medicaid article:
- Anti-VEGF Medical Step Therapy Notice
- Important reminder: Coding requirements for reimbursement for early elective deliveries
- Transition to AIM small joint guidelines

December 2020 Anthem Provider News - Wisconsin Medicaid Dec 1, 2020

CAHPS education for providers

December 2020 Anthem Provider News - Wisconsin Medicaid Dec 1, 2020

Notifications on the Availity Portal

December 2020 Anthem Provider News - Wisconsin Medicaid Dec 1, 2020

Resources to support your pregnant and postpartum patients and their families

December 2020 Anthem Provider News - Wisconsin Medicaid Dec 1, 2020

Sign up to receive email from Anthem Blue Cross and Blue Shield

December 2020 Anthem Provider News - Wisconsin Medicaid Dec 1, 2020

Digital transactions cut administrative tasks in half

December 2020 Anthem Provider News - Wisconsin Medicaid Dec 1, 2020

Transition to AIM small joint guidelines

December 2020 Anthem Provider News - Wisconsin Medicare Dec 1, 2020

2021 Medicare Advantage individual benefits and formularies

December 2020 Anthem Provider News - Wisconsin Medicare Dec 1, 2020

Medicare Advantage Group Retiree Member Eligibility, Alpha Prefix FAQ

December 2020 Anthem Provider News - Wisconsin Medicare Dec 1, 2020

Medical policies and clinical utilization management guidelines update

December 2020 Anthem Provider News - Wisconsin Medicare Dec 1, 2020

Policy Update: Emergency Department: Leveling of Evaluation and Management Services

December 2020 Anthem Provider News - Wisconsin Medicare Dec 1, 2020

Digital transactions cut administrative tasks in half

December 2020 Anthem Provider News - Wisconsin Medicare Dec 1, 2020

Medicaid News - November 2020

View these Medicaid article:
- Evaluation and management services correct coding
- New specialty pharmacy medical step therapy requirements
- Provider Chat: A fast, easy way to get your questions answered
- New specialty pharmacy medical step therapy requirements
- Update: Notice of changes to the AIM Musculoskeletal Program prior authorization requirements and setting determinations
- Electronic visit verification notification
November 2020 Anthem Provider News - Wisconsin Medicaid Nov 1, 2020

Digital transactions cut administrative tasks in half

November 2020 Anthem Provider News - Wisconsin Medicaid Nov 1, 2020

Medical drug benefit clinical criteria updates

November 2020 Anthem Provider News - Wisconsin Medicaid Nov 1, 2020

Prior authorization requirements for HCPCS code 55899

November 2020 Anthem Provider News - Wisconsin Medicaid Nov 1, 2020

Medicare News - November 2020

View these Medicare articles:
- AIM rehabilitation prior authorizations suspended for Group Retiree Solutions members until December 31, 2020
- Transition to AIM Rehabilitative Service Clinical Appropriateness Guidelines
- AIM Musculoskeletal program expansion postponed
November 2020 Anthem Provider News - Wisconsin Medicare Nov 1, 2020

Inhaled nitric oxide reviews for diagnosis-related group admissions

November 2020 Anthem Provider News - Wisconsin Medicaid Nov 1, 2020

Transition to AIM Rehabilitative Service Clinical Appropriateness Guidelines

November 2020 Anthem Provider News - Wisconsin Medicaid Nov 1, 2020

Provider Chat: A fast, easy way to get your questions answered

November 2020 Anthem Provider News - Wisconsin Medicare Nov 1, 2020

Provider transparency update

November 2020 Anthem Provider News - Wisconsin Medicaid Nov 1, 2020

Digital transactions cut administrative tasks in half

November 2020 Anthem Provider News - Wisconsin Medicare Nov 1, 2020

Coding spotlight: Tips and best practices for compliance

November 2020 Anthem Provider News - Wisconsin Medicaid Nov 1, 2020

FDA approvals and expedited pathways used - new molecular entities

November 2020 Anthem Provider News - Wisconsin Medicare Nov 1, 2020

Federal Employee Program® expands specialty pharmacy prior authorization list*

October 2020 Anthem Provider News - Wisconsin Federal Employee Plan (FEP) Oct 1, 2020

Update: Notice of changes to the AIM Musculoskeletal Program prior authorization requirements and setting determinations

October 2020 Anthem Provider News - Wisconsin Medicaid Oct 1, 2020

Prior authorization requirements for E0482

October 2020 Anthem Provider News - Wisconsin Medicaid Oct 1, 2020

Patient360 enhancement for medical providers

October 2020 Anthem Provider News - Wisconsin Medicaid Oct 1, 2020

Coding spotlight: Providers guide to coding for behavioral health disorders

October 2020 Anthem Provider News - Wisconsin Medicaid Oct 1, 2020

Medicare News - October 2020

View these Medicare articles:
- Evaluation and management services correct coding
- Medical policies and clinical utilization management guidelines update
- Prior authorization requirements for the below codes effective January 2021
October 2020 Anthem Provider News - Wisconsin Medicare Oct 1, 2020

Medical drug benefit clinical criteria updates

October 2020 Anthem Provider News - Wisconsin Medicare Oct 1, 2020

Prior authorization requirements for the below codes effective January 1, 2021

October 2020 Anthem Provider News - Wisconsin Medicare Oct 1, 2020

Social determinants of health support expanding with GroundGame Health

October 2020 Anthem Provider News - Wisconsin Medicare Oct 1, 2020

Provider transparency update

October 2020 Anthem Provider News - Wisconsin Medicare Oct 1, 2020

Medical drug benefit clinical criteria updates

September 2020 Anthem Provider News - Wisconsin Medicaid Sep 1, 2020

Medical policies and clinical utilization management guidelines update

September 2020 Anthem Provider News - Wisconsin Medicaid Sep 1, 2020

What Matters Most online training course: Improving patient experience

September 2020 Anthem Provider News - Wisconsin Medicaid Sep 1, 2020

Update: Notice of changes to the AIM musculoskeletal program

September 2020 Anthem Provider News - Wisconsin Medicare Sep 1, 2020

Medical drug benefit clinical criteria updates

September 2020 Anthem Provider News - Wisconsin Medicare Sep 1, 2020

Medicaid News - August 2020

View this Medicaid article:
- Updates to AIM musculoskeletal program clinical appropriateness guidelines
August 2020 Anthem Provider News - Wisconsin Medicaid Aug 1, 2020

Transition to AIM Rehabilitative Services clinical appropriateness guidelines

August 2020 Anthem Provider News - Wisconsin Medicaid Aug 1, 2020

Medical drug benefit clinical criteria updates

August 2020 Anthem Provider News - Wisconsin Medicaid Aug 1, 2020

New MCG Care Guidelines 24th edition

August 2020 Anthem Provider News - Wisconsin Medicaid Aug 1, 2020

Medicare News - August 2020

View these Medicare articles:
- Submit behavioral health authorizations via our online Interactive Care Reviewer (ICR) tool
- Updates to AIM musculoskeletal program clinical appropriateness guidelines
- Provider data update
- Waived copays, deductibles and coinsurance for CCM, complex CCM and TCM
- AIM Musculoskeletal program expansion
- New MCG Care Guidelines 24th edition
August 2020 Anthem Provider News - Wisconsin Medicare Aug 1, 2020

Provider data update

August 2020 Anthem Provider News - Wisconsin Medicaid Aug 1, 2020

Medical drug benefit clinical criteria updates

August 2020 Anthem Provider News - Wisconsin Medicare Aug 1, 2020

Controlling high blood pressure (CBP)

August 2020 Anthem Provider News - Wisconsin Medicaid Aug 1, 2020

2020 Medicare risk adjustment provider trainings

August 2020 Anthem Provider News - Wisconsin Medicare Aug 1, 2020

Medicaid News - July 2020

View these Medicaid articles:
- Updates to AIM Specialty Health advanced imaging clinical appropriateness guidelines
- Modifier use reminders
- Medical policies and clinical utilization management guidelines update
- New behavioral health discharge call-in line
July 2020 Anthem Provider News - Wisconsin Medicaid Jul 1, 2020

Medical drug benefit clinical criteria updates

July 2020 Anthem Provider News - Wisconsin Medicaid Jul 1, 2020

Submit behavioral health authorizations via our online Interactive Care Reviewer tool

July 2020 Anthem Provider News - Wisconsin Medicaid Jul 1, 2020

Coding spotlight: Provider’s guide to coding for cardiovascular conditions

July 2020 Anthem Provider News - Wisconsin Medicaid Jul 1, 2020

Admission review process for Anthem Blue Cross and Blue Shield Federal Employee Program® (FEP) members

July 2020 Anthem Provider News - Wisconsin Federal Employee Plan (FEP) Jul 1, 2020

Medicare News - July 2020

View these Medicare articles:
- New behavioral health discharge call-in line
- Medical policies and clinical utilization management guidelines update
- Updates to AIM Specialty Health advanced imaging clinical appropriateness guidelines
- Transition to AIM rehabilitative services clinical appropriateness guidelines
- Modifier use reminders
July 2020 Anthem Provider News - Wisconsin Medicare Jul 1, 2020

Prior authorization codes moving from AIM Specialty Health to Anthem Blue Cross and Blue Shield

July 2020 Anthem Provider News - Wisconsin Medicare Jul 1, 2020

2020 affirmative statement concerning utilization management decisions

July 2020 Anthem Provider News - Wisconsin Medicare Jul 1, 2020

Medical drug benefit clinical criteria updates

July 2020 Anthem Provider News - Wisconsin Medicare Jul 1, 2020

In-Office Assessment Program

July 2020 Anthem Provider News - Wisconsin Medicare Jul 1, 2020

2020 Special Needs Plans

July 2020 Anthem Provider News - Wisconsin Medicare Jul 1, 2020

Medicaid News - June 2020

View these Medicaid articles:
- Resources supporting our providers during COVID-19
- Acquisition of Beacon Health Options
- MCG care guidelines – 24th edition
- November 2019 Medical Policies and Clinical Utilization Management Guidelines update
June 2020 Anthem Provider News - Wisconsin Medicaid Jun 1, 2020

Updates to AIM Sleep Disorder Management Clinical Appropriateness Guideline

June 2020 Anthem Provider News - Wisconsin Medicaid Jun 1, 2020

Coding spotlight - provider’s guide to code social determinants of health

June 2020 Anthem Provider News - Wisconsin Medicaid Jun 1, 2020

Modifier use reminders

June 2020 Anthem Provider News - Wisconsin Medicaid Jun 1, 2020

2020 affirmative statement concerning utilization management decisions

June 2020 Anthem Provider News - Wisconsin Medicaid Jun 1, 2020

Follow-Up After Hospitalization for Mental Illness

June 2020 Anthem Provider News - Wisconsin Medicaid Jun 1, 2020

Complex Case Management program

June 2020 Anthem Provider News - Wisconsin Medicaid Jun 1, 2020
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